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CPE-004 · synthetic case IRON-FX-09

Heart failure with ferritin 180 and TSAT 14

Ferritin 100–299 with low saturation meets the heart-failure definition.

Synthetic · no real patientAuthored by Biod · reviewed by Dr. AmaralIron engine v1.0.0

Purpose: Ferritin 100–299 with low saturation meets the heart-failure definition.

Inputs the engine received

Iron studies

Ferritin
180 ng/mL
Serum iron
38 µg/dL
TIBC
270 µg/dL

CBC

Hemoglobin
12.9 g/dL

Patient

Age
74 years
Sex
Male

Conditions and risk groups

Heart failure
Yes

What the engine reports

Priority

Gastrointestinal evaluation to consider

ID-GI-01

Iron-deficiency anemia in a man needs a gastrointestinal source considered. AGA 2020 suggests bidirectional endoscopy for asymptomatic men and postmenopausal women. The evaluation is the physician's decision.

Detected clinical pattern

Biochemical Pattern Compatible with Iron-Deficiency Anemia

Anemia (Hb 12.9 g/dL) with an iron-deficiency criterion met. The cause still has to be found.

  • Anemia: Anemia (Hb 12.9 g/dL)
  • Stage: Stage 3 · anemia

Why this pattern was identified

  • Heart-failure iron deficiency. Ferritin 180 ng/mL with transferrin saturation 14.1% meets the heart-failure definition (ferritin <100, or 100–299 with TSAT <20%).
  • Supportive indices. TSAT 14.1% are consistent with iron-limited red-cell production.

Calculations

Transferrin saturation
14.1%

Serum iron ÷ TIBC × 100.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Consider bidirectional endoscopy and review colorectal cancer screening status (AGA 2020).Men and postmenopausal women with iron-deficiency anemia.
  2. 2Physician to review the heart-failure iron-repletion pathway.AHA/ACC/HFSA 2022.
  3. 3Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
  4. 4Consider celiac serology (tissue transglutaminase IgA with total IgA) and H. pylori testing.AGA 2020; ACG 2023.

Missing information

  • MCV (to place the anemia as microcytic, normocytic or macrocytic).
Evidence and rule trace · 6 rules

ID-CALC-01Derived values

Inputs: iron 38, TIBC 270

Derived values calculated.

ID-ST-06Heart-failure iron deficiency criterion

Inputs: ferritin 180 ng/mL · TSAT 14.1% · heart failure

Iron deficiency by the AHA/ACC/HFSA heart-failure definition.

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 12.9 g/dL (<13)

Anemia by WHO hemoglobin thresholds.

ID-11Iron-deficiency anemia pattern

Inputs: hemoglobin 12.9 g/dL · ferritin 180 ng/mL · TSAT 14.1%

Biochemical pattern compatible with iron-deficiency anemia (stage 3).

ID-GI-01Gastrointestinal evaluation: men and postmenopausal women

Inputs: male · iron-deficiency anemia pattern

Priority review: gastrointestinal source to be considered.

ID-CEL-01Celiac and H. pylori consideration

Inputs: iron-deficiency anemia pattern · celiac serology not documented

Consider celiac serology and H. pylori testing.

Evidence

  • EV-WHO-FERR-2020 · World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO; 2020.
  • EV-WHO-HB-2011 · World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011.
  • EV-AGA-2020 · Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020;159(3):1085-1094.
  • EV-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-LOPEZ-2016 · Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-916.
  • EV-AHA-HF-2022 · Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032.
  • EV-ACG-CELIAC-2023 · Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. Am J Gastroenterol. 2023;118(1):59-76.
  • EV-MENTZER-1973 · Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.

Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety considerations. It does not diagnose, find a cause, or select an iron product, dose or route. Physician adjudication is required.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

Stage of iron deficiency

  1. ✓ 1 · Stores depleted

    Low ferritin, normal CBC

  2. ✓ 2 · Iron-deficient erythropoiesis

    Low TSAT or reticulocyte Hb, Hb still normal

  3. ● 3 · Anemia

    Hemoglobin below the WHO threshold

Against typical reference intervals

Ferritin180 ng/mL · within reference
ref 30300
Iron studiesDrag or type
  • <15 depleted
  • 15–29 low
  • 30–44 borderline
  • 45–299
  • 300–999 high
  • >1000 very high

Calculated from iron ÷ TIBC when both are entered.

Above 5 mg/L the engine reads ferritin as inflammation-affected.

CBC
  • <7 severe
  • 7–11.9 anemia range
  • 12–12.9 (men <13)
  • ≥13
Patient
Sex
Symptoms and findings
Conditions and risk groups
Work-up and treatment context

Live result · computed in your browser

Priority

Gastrointestinal evaluation to consider

ID-GI-01

Iron-deficiency anemia in a man needs a gastrointestinal source considered. AGA 2020 suggests bidirectional endoscopy for asymptomatic men and postmenopausal women. The evaluation is the physician's decision.

Detected clinical pattern

Biochemical Pattern Compatible with Iron-Deficiency Anemia

Anemia (Hb 12.9 g/dL) with an iron-deficiency criterion met. The cause still has to be found.

  • Anemia: Anemia (Hb 12.9 g/dL)
  • Stage: Stage 3 · anemia

Why this pattern was identified

  • Heart-failure iron deficiency. Ferritin 180 ng/mL with transferrin saturation 14.1% meets the heart-failure definition (ferritin <100, or 100–299 with TSAT <20%).
  • Supportive indices. TSAT 14.1% are consistent with iron-limited red-cell production.

Calculations

Transferrin saturation
14.1%

Serum iron ÷ TIBC × 100.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Consider bidirectional endoscopy and review colorectal cancer screening status (AGA 2020).Men and postmenopausal women with iron-deficiency anemia.
  2. 2Physician to review the heart-failure iron-repletion pathway.AHA/ACC/HFSA 2022.
  3. 3Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
  4. 4Consider celiac serology (tissue transglutaminase IgA with total IgA) and H. pylori testing.AGA 2020; ACG 2023.

Missing information

  • MCV (to place the anemia as microcytic, normocytic or macrocytic).
Evidence and rule trace · 6 rules

ID-CALC-01Derived values

Inputs: iron 38, TIBC 270

Derived values calculated.

ID-ST-06Heart-failure iron deficiency criterion

Inputs: ferritin 180 ng/mL · TSAT 14.1% · heart failure

Iron deficiency by the AHA/ACC/HFSA heart-failure definition.

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 12.9 g/dL (<13)

Anemia by WHO hemoglobin thresholds.

ID-11Iron-deficiency anemia pattern

Inputs: hemoglobin 12.9 g/dL · ferritin 180 ng/mL · TSAT 14.1%

Biochemical pattern compatible with iron-deficiency anemia (stage 3).

ID-GI-01Gastrointestinal evaluation: men and postmenopausal women

Inputs: male · iron-deficiency anemia pattern

Priority review: gastrointestinal source to be considered.

ID-CEL-01Celiac and H. pylori consideration

Inputs: iron-deficiency anemia pattern · celiac serology not documented

Consider celiac serology and H. pylori testing.

Evidence

  • EV-WHO-FERR-2020 · World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO; 2020.
  • EV-WHO-HB-2011 · World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011.
  • EV-AGA-2020 · Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020;159(3):1085-1094.
  • EV-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-LOPEZ-2016 · Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-916.
  • EV-AHA-HF-2022 · Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032.
  • EV-ACG-CELIAC-2023 · Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. Am J Gastroenterol. 2023;118(1):59-76.
  • EV-MENTZER-1973 · Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.

Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety considerations. It does not diagnose, find a cause, or select an iron product, dose or route. Physician adjudication is required.

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IRON-FX-03

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IRON-FX-04

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IRON-FX-05

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Hb 10.4 with a ferritin that looks normal and a CRP of 18.

IRON-FX-06

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Ferritin looks near normal but sits under the WHO inflammation cutoff of 70.

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